Communication Skills

• Shirley Thompson
Reviewed March 2019
 Objectives
• To explain what facilitative skills are
• State what are cues
• Why is it important to pick up on cues
• Describe blocking behaviours when we
communicate
• List patients barriers to communication
 Communication skills
Facilitative skills
Are used to:

• Gather patient information

(Identify patient’s history/agenda/needs/concerns)

• Acknowledge patient’s agenda/concerns

• Negotiate decision-making

• Give tailored information effectively

 Communication Skills

Skills Communicates
Open questions: “ I want to know about you”
“how are you?”
“tell me”
Open directive questions: “I think you might have concerns
“what’s most important to you or needs and I want to help”
right now?”
“how did you feel when you
heard..?”
 Communication Skills

Skills Communicates
Educated guesses: “I have an idea about how you
“I imagine that news came as may be feeling. Do you want to
quite a shock” tell me”
Negotiation: “ I am willing to listen but I can
“are you able to say what is see it is hard and I do not want
worrying you” to pry”
Summarising: “demonstrates that you have
“I would like to check out that I been listening”
have understood what you have
told me”
 Communication Skills
Skill Communicates
Clarifying: “I would like to understand
“what were the things about exactly what the problem is”
being ill that upset you the most”

Paraphrasing: “ I want you to know I’ve heard

“being ill has been really
distressing”
Acknowledging/reflection:
“you had a rotten time by the
sounds of it”
“you look/sound upset”
you and also to check that I've
got it right”
“how you feel matters”
“I can see you are upset, it is Ok
to tell me about it and I want to
help”
 Cues

• “A verbal or non verbal hint which suggests an underlying

unpleasant emotion and would need clarification from the
health provider” Del Piccolo et al, 2006
CUES
 Non-verbal cues
• Clear expression of a negative or unpleasant
emotion (eg. crying)

• Hints to hidden emotions (sighing, silence,

frowning, negative body posture)
 Types of Cues

• Psychological symptoms
• Words/phrases which describe physiological distress
• Words/phrases suggesting vague or undefined emotions
• Verbal hints to hidden concerns
• Mention of a life event/repeated or emphasised mention
of a neutral event
• Mention of a life threatening illness
 Blocking Questions
Physical Did you have a lot of symptoms
Closed Did you tell anyone?
Multiple How are you, is the pain any better
leading You’ll feel better in a minute won’t you?
Defending/justifying I am sure the doctor did not mean to
upset you
Premature reassurance You will feel better after you have seen
the doctor
Premature advice You need to
Normalising Everyone gets upset when they are ill

Minimising It wont be as bad as you think

Jollying along Come on you have to stay positive

Blocking behaviours
• Overt blocking - Complete change of topic
– Pt “I was upset about being ill”
– Int “How’s your family”

• Distancing strategies - more subtle

– Change of time frame - “Are you upset now?”
– Change of person - “and was your wife upset?”
– Removal of emotion - “How long were you ill for?”

Wilkinson 1991; Wilkinson et al 2008; Maguire et al 1996

 Professional barriers to communication

Fears
•Unleashing strong emotions
•Making things worse
•Facing difficult questions
•Taking up too much time
Beliefs
•Emotional problems are inevitable
and nothing can be done about them
•Its not my role to discuss such
things
•There's no point talking about
problems that cannot be solved

Lack of skills or confidence in Workplace

•Starting end of life discussions •Lack of support from colleagues or
•Exploring concerns managers
•Handling difficult questions – •Lack of privacy
saying the ‘right thing’ •Time constraints
•Closing the conversation sensitively •Noise/distractions
•Nowhere to refer for psychological
support
•No training or supervision in
communication skills
 Patient Barriers
Skills Environment
Not being able to find the right words •Not having privacy
Do not have sufficient command of the •Protecting a relative who is present
language •Not having somebody present who
Embarrassing literacy levels should be
Not understanding enough to know
how to clarify things
Issues of mental capacity

Other
•Relevant questions were not asked
•Patient cues met by distancing
• To communicate well is always a challenge,
especially in a busy working environment. What
we must remember is that good communications
can help a patient and their families to survive
their journey through diagnosis and treatment,
with better outcomes for all concerned.
• The evidence also suggest that if professionals
are competent communicators it can increase
confidence and prevent burnout.
 References
• Maguire, P Booth K., Elliot C., Jones B. (1996). Helping health professionals involved
in cancer care acquire key interviewing skills – the impact of workshops. European
Journal of Cancer 32A (9):1486-1489.

• Del Piccolo L., Goss C. & Bergvik S. (2006). The fourth meeting of the Verona
Network on Sequence Analysis. “Consensus finding on the appropriateness of
provider responses to patient cues and concerns. Patient Education and Counseling,
EACH Pages, 61, 473-475.

• Wilkinson S., Perry R., Blanchard K. (2008) Effectiveness of a three day

communication skills course in changing nurses communication skills with cancer/
palliative care patients; a randomized controlled trial. Palliative Medicine 22 365-375

• Wilkinson SM (1991). Factors which influence how nurses communicate with cancer
patients; Journal of Advanced Nursing 16: 677 -688